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Insurance Form

Effective from - Jan 30 2025
To view other versions open the versions tab on the right

 

Insurance Form

(to be filled by the Lessor and the Lessee at the beginning of the Finance agreement)

Lessor and Lessee Information
 (Lessor)(Lessee)

National ID number for

Saudi nationals

Commercial

Registration No.

  

Name of Lessee and

Lessor

  
Phone number  
National Address  

Vehicle Details

 Chassis No. Registration Plate No.
 Vehicle Registration Expiry Date Vehicle Color
 Customs Card No. Type of Chassis
 Year of Manufacture Vehicle Make
 

Names of

Authorized Drivers

 Vehicle Model
 Annual Depreciation Percentage of Motor Vehicle Actual Value of Motor Vehicle
The approximate value of the Motor Vehicle for the next years from the Motor Vehicles Financially Leased Contract.
First Year: (actual value of Motor Vehicle selling price) 
Second Year: (Motor Vehicle value based on depreciation percentage) 
Third Year: (Motor Vehicle value based on depreciation percentage) 
Forth Year: (Motor Vehicle value based on depreciation percentage) 
Fifth Year: (Motor Vehicle value based on depreciation percentage) 
Deductible 
Additional Benefits 
Repair Method (dealerships or certified auto repair shops)